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Primary spermatocytes undergo meiosis as the cells successively pass through the preleptotene, leptotene, zygotene, and pachytene stages to become secondary spermatocytes. Isolated FSH deficiency This is a very rare cause of infertility. Intrauterine insemination is a process by which sperm is washed and prepared for placement into the uterine cavity, therefore bypassing the cervix and bringing a higher concentration of motile sperm closer to the tubes and ovulated egg. These high-tech and expensive male infertility treatments give sperm an artificial boost to get into an egg. Smoking during pregnancy increases the chance of pregnancy loss. Therefore we recommend a fertility evaluation if a couple has been attempting pregnancy for 6 months or more when the woman is 35 years of age or older.

WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. Generally, evaluation should be offered to couples who have not conceived after one year of unprotected vaginal intercourse. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems. Potential causes are unknown, but it may be related to infection, vascular disease, or bilateral testicular torsion. The abnormalities need to be evaluated from a genetic point of view because any male offspring would inherit the same issue as the father. Hypothyroidism: Low thyroid hormone levels--can cause poor semen quality, poor testicular function and may disturb libido.  May be caused by a diet high in iodine.  Reducing iodine intake or beginning thyroid hormone replacement therapy can elevate sperm count.  This condition is found in only 1 percent of infertile men.

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Gonadotropins can trigger ovulation when Clomid or Serophene don't work. In-vitro fertilization (IVF): Sperm are placed with unfertilized eggs in a petri dish, where fertilization can take place. Donor semen should be free from any STI-producing organisms, including HIV. Infertility and impaired fecundity in the United States, 1982–2010: data from the National Survey of Family Growth.

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For an appendectomy, the right shoulder can be particularly painful. That is why a complete build-up of the endometrial mucosa is not possible anymore. Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance.

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Some medications increase the risk of fertility problems in men. A typical disease is polycystic ovarian syndrome. A review of systems and physical examination of the endocrine and gynecologic systems should be performed. Surgical sperm aspiration: The sperm is removed from part of the male reproductive tract, such as the vas deferens, testicle, or epididymis. These and many other questions will help your physician design a specific evaluation and potential treatment for you. Some respond by actively avoiding the issue altogether; middle-class men are the most likely to respond in this way.[21] In the United States some treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for Family and Medical Leave Act leave. Blood tests Depending on the individual couple's situation, various blood tests on either the female or the male may be needed. It has been proven useful in overcoming infertility conditions, such as blocked or damaged tubes, endometriosis, repeated IUI failure, unexplained infertility, poor ovarian reserve, poor or even nil sperm count. Fertilizing Capacity of Epididymal and Testicular Sperm using Intracytoplasmic Sperm Injection (ICSI). (PDF, 7 MB)Reproduction, Fertility and Development, 1995.